Influence of hydroxyethyl starch (HES) 130/0.4 on hemostasis as measured by viscoelastic device analysis: a systematic review

Intensive Care Med (2011) 37:17251737DOI 10.1007/s00134-011-2385-z SYSTEMATIC REVIEW

Christiane S. Hartog Dorit Reuter Wolfgang Loesche Michael Hofmann Konrad Reinhart

Inuence of hydroxyethyl starch (HES) 130/0.4 on hemostasis as measured by viscoelastic device analysis: a systematic review

Abstract Purpose: Hydroxyethyl starch solutions (HES) are plasma volume expanders which affect hemostasis. Newer HES 130/0.4 is said to be safer. Reevaluation of published evidence is necessary after the recent retraction of studies. Methods: Systematic review of studies assessing HES 130/0.4 effects on hemostasis by thrombelastography (TEG, ROTEM) or Sonoclot (SCR) in comparison with crystalloid or albumin control uids was performed. Only studies which provided statistical comparisons between study uids were analyzed. Studies were divided into in vitro or in vivo hemodilution studies. We assessed study quality, HES effects which differed signicantly from controls, values outside normal range, degree of hemodilution, and cumulative HES dose. Results: Seventeen in vitro and seven in vivo hemodilution studies were analyzed. Four studies reported quality control measures. Nineteen studies (all 15 ROTEM studies, 3 of 5 in vitro TEG, and 1 of 2 SCR studies) showed a signicant hypocoagulatory

effect of HES 130/0.4 on clot formation, while clotting time was not uniformly affected. Three in vivo TEG studies with low HES doses or cancer patients found mixed or nonsignicant results. In studies which provided normal ranges (n = 9), more values were outside normal ranges in the HES than in the control groups (87/122 vs. 58/122,p \ 0.001). Dose effects were apparent in the in vitro studies, which investigated higher dilutions up to 80%. In vivo studies were fewer and did not investigate doses [40 ml/kg.

Conclusions: HES 130/0.4 administration results in a weaker and smaller clot. Until results from well-designed clinical trials are available, safer uids should be chosen for patients with impaired coagulation.

Keywords Plasma volume expanders Thrombelastography

Coagulopathy Colloids

Received: 29 July 2011Accepted: 20 September 2011Published online: 12 October 2011 Copyright jointly held by Springer and

ESICM 2011

C. S. Hartog and D. Reuter contributed equally to this work.

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C. S. Hartog D. Reuter W. Loesche

M. Hofmann K. Reinhart

Department for Anesthesiology and Intensive Care Medicine, Jena...